A 70-year-old man visited our outpatient clinic with chief complaints of severe upper abdominal pain and fever. Blood tests revealed a markedly enhanced inflammatory reaction. He was hospitalized and diagnosed with phlegmonous gastritis based on findings of esophagogastroduodenoscopy and multidrug-resistant streptococcus detected by gastric juice culture. The clinical symptoms promptly resolved after starting concomitant treatment with vancomycin hydrochloride and levofloxacin. Administration of vancomycin hydrochloride for phlegmonous gastritis was not found in our literature search and the present case is thus considered to provide a valuable example of such use.
A 90-year-old woman was admitted to our hospital because of dizziness, without any remarkable abdominal symptoms. Severe anemia was found and thus gastrointestinal investigations were performed. CT and ultrasonography showed the specific multiplex layer configuration at the anal side of the descending colon. Colonoscopy showed a round tumor occupying the lumen and a consecutive gastrografin enema showed a crab-claw-like area without filling in the descending colon. Intussusception of the colon was diagnosed and partial resection of the descending colon was performed, but without relief of intussusception. The tumor was histologically diagnosed as mucinous adenocarcinoma. By various factors, incomplete fixation between the retroperitoneum and the descending colon might result in the present condition.
An 81-year-old woman was admitted complaining of left lower abdominal pain. Computed tomography on admission revealed foreign a body penetrating descending colon and free air. We extracted the foreign body endoscopically. The foreign body was a sharp-edged fish bone. She was treated by conservative medication without complication.
A 53-year-old man was diagnosed as having idiopathic thrombocytopenic purpura (ITP). Hematochezia appeared under steroid therapy for ITP after the diagnosis of ITP 18 months. Colonoscopic study demonstrated inflamed rectal mucosa but there was no evidence of infectious colitis. The colonoscopic and pathological findings were compatible with ulcerative colitis (UC). There have been a few reports of patients with UC complicated by ITP, but in all except one report, UC preceded ITP. This is the third case in which ITP preceded UC and the first case in which the proctitis type of UC was complicated by ITP in Japan.
We had three cases of pancreatic groove carcinoma. All cases developed obstructive jaundice. Duodenoscopy showed stenosis of the second portion of the duodenum in every case. Thus, endoscopic bile duct drainage could not be performed in two cases. CT revealed a mass between the duodenum and head of the pancreas, which was not well-defined by contrast-enhancement. Endoscopic ultrasonograghy revealed a hypoechoic mass which was adjacent to the common bile duct and duodenum in the pancreas head in all cases. Therefore, we could diagnose pancreatic groove carcinoma.
A 64-year-old woman underwent an ileocecectomy in July 2002 for ruptured cecal carcinoma, which was a well-differentiated adenocarcinoma, stage II, ss, ly0, v0, n (-). In August 2005, abdominal CT revealed a tumor 20mm in diameter in the pancreatic tail, therefore, a distal pancreatectomy and splenectomy were performed. The pancreatic tumor resembled the moderately differentiated cecal adenocarcinoma, both having p53 and k-ras point mutations in common, and it was diagnosed as a metastasis of the cecal carcinoma.
A 26-year-old woman was admitted to our hospital with jaundice. Under a diagnosis of biliary and duodenal stenosis due to so called "groove pancreatitis", prednisolone (30mg/day, 2 weeks) was administered. But these stenosis did not improve after the treatment, and pancreaticoduodenectomy was performed. Histlogically, poorly differentiated adenocarcinoma was found in the "groove" between the duodenum and the pancreatic head. We should be kept of "pancreatic groove carcinoma" in mind when making a diagnosis of "groove pancreatitis".
With the cumulative increase in the number of autoimmune pancreatitis cases, the disease is now widely accepted as a symptom of IgG4-related systemic disease. We recently experienced two cases of retroperitoneal fibrosis and Castleman disease presenting high IgG4 levels without evident pancreatic lesions. Both patients were successfully treated with steroid therapy. It is necessary to acknowledge that retroperitoneal fibrosis and Castleman disease, with or without pancreatic lesions, may have aspects of IgG4-related systemic disease and that the measurement of serum IgG4 and tissue immunostaining for IgG4 should be considered for diagnosing and treating the conditions.